Against Health-Care Determinism

That's a neat trick. Arnold Relman, the Harvard Medical School expert who wrote TNR's cover story on universal health care a few months back, somehow got David Francis to rewrite his whole article for the Christian Science Monitor, complete with lots of quotations from, yes, Arnold Relman. Well played!

Relman's basic argument is that the next 5-10 years will see the ascension of consumer-driven health solutions: HSA's, MSA's, and all the other acronyms that mean you, not your employer, are now responsible for the majority of your health care expenditures. Relman thinks this revolution will fail, and when it does, single-payer will be the last option left standing and we'll adopt it.

I wish. We've been down this road before, most recently with less ruthless forms of cost-sharing and the managed care revolution. And how'd that turn out?

In most countries, health spending increased more rapidly than GDP. U.S. health spending as a percentage of GDP increased by 1.6 percentage points from 1992 to 2003 (from 13.0 percent to 14.6 percent)—twice the OECD median increase of 0.8 percentage points. This was during a period when managed care and greater cost sharing were credited for holding down U.S. health spending.

So instead of abandoning course, we've simply gone to more "cost-sharing". At a point, this just becomes cost-shunting. But at that point, single-payer loses an ally.